How Long Does It Take To Receive Benefits?

Once you file a claim, your employer’s insurance company has up to 5 business days to either accept or deny it. The insurance company will pay out your benefits once they accept your claim. If your employer fails to file a claim within the allotted time frame, or the insurance company does not respond in time, it may be best to seek legal assistance.

Temporary Disability Benefits: If your claim is accepted and you are unable to work due to your injury, you may start receiving temporary disability benefits. These benefits typically start after a waiting period of 3 days (unless you are off work for 14 days or more). Once the waiting period is over, the insurance company will pay retroactively.

Permanent Disability Benefits: If the injury leads to permanent impairment, your employer’s insurance company will conduct a medical evaluation and determine the extent of the disability. This process can take a few months before they begin to pay out your benefits.

Overall, the timeline for receiving workers compensation benefits depends on the type of case and claim. There are many factors to consider when filing a claim, like the severity of your injury or what benefits you are looking for. To learn more about what benefits you qualify for, click here.

There are several reasons why a claim can be delayed. Some reasons include:

• Incomplete or Missing Documentation: If your claim or medical paperwork isn’t fully completed, the insurance company will delay your benefits until everything is submitted correctly. This might include missing medical records, incomplete forms, or even issues with the employer’s report of the injury. Your insurance company will check to make sure all information provided is correct and consistent. For assistance with this process, you can consider getting a lawyer to ensure all paperwork is properly taken care of.
• Medical Evaluation or Disagreements: If there’s a delay in getting your necessary medical evaluations, or if there’s a disagreement over the diagnosis/extent of your injury, your insurance may delay benefits until the matter is resolved.
• Non-Compliance with Treatment or Restrictions: If you aren’t following the treatment plan recommended by your doctor or are failing to comply with medical restrictions, the insurance company may delay your benefits while they investigate your case further.
• Fraud Investigations: If there’s suspicion of fraud or if the insurer is conducting an in-depth investigation into your claim, it could delay your benefits process.

If your benefits are delayed for any reason, there are a few things you can do to fix things. Some of your options include:

• Reviewing Your Claim: Double-check that all required documentation is submitted and up-to-date. Missing paperwork or additional medical information can cause delays in processing. You will want to ensure your employer also filed your claim properly.
• Contact a Claims Adjuster: When benefits are delayed, you can reach out to the claims adjuster handling your case. Sometimes delays are just due to administrative issues, so it’s worth checking in for an update or clarification on why the delay occurred.
• Request a Written Explanation: If there’s no clear reason for the delay, you can request a written explanation from the insurance company or claims adjuster outlining why the benefits haven’t been paid.
• Contact the Oregon Workers’ Compensation Division: If you cannot resolve the issue directly with the insurer, you can reach out to the Oregon Workers’ Compensation Division. They can offer assistance in resolving disputes or delays.
• File a Formal Complaint: If your benefits are still delayed or denied after following up, you have the option to file a formal complaint with the Workers’ Compensation Division. You can also ask for a hearing with the Workers’ Compensation Board to appeal any decisions or delays.
• Consider Legal Help: If the delay persists or if your claim is being unfairly delayed or denied, consulting a workers’ compensation attorney can help ensure your rights are protected and that you receive the benefits you’re entitled to. To learn just what a lawyer can do for you, click here.

Additionally, your benefits claim may be denied outright. To learn more about claim denials, click here.

Workers’ compensation attorneys usually work on a contingency fee basis, meaning they only get paid if you win or settle your case. Their fees are generally capped by the state between 10-15% of the compensation awarded, but this depends on the case. For more information on rates, click here.

To see if you qualify for financial assistance, consult the lawyer or firm you are wanting to work with. You can also contact the Oregon Workers’ Compensation Division. For assistance with costs, click here.

Some workers compensation cases are simple and require little to no assistance. For more complex cases, a competent lawyer can be an invaluable asset. To see if a lawyer is right for you and a free case consultation, contact us at 888-813-3188.